Hospital Rate of Payment:
Upfront Payments to hospitals:
Unlimited.
Planned PMB procedures are
subject to DSP hospital networks
& co- payment for use of non-DSP
applies. Procedure co-payments
may also be applicable. Subject
to Scheme Protocols and
option-specific exclusion list.
For procedural and admissio...
Casualty / Emergency Visits:
Subject to MSA Unless PMB
Specialists:
Non-Contracted Providers at
100% of Scheme Rate. Contracted
Providers at 100% of Contracted
Rate.
Dialysis:
Covered at Network Provider. Subject
to Scheme Protocols and PMB. Preauth
required.
Oncology / Cancer:
Unlimited. Subject to ICON Network
and standard protocols. Pre-auth
required. 40% NON DSP CO
payment. Biologicals and Targeted
Therapies Sub limit R273 000
Medical and Surgical Appliances:
Subject to Benefit Booster and PMB’s
Take home Medicine:
Maximum of 7 days’ supply
Rehabilitation, Hospice and Step-down facilities:
Limited to Network Providers
and subject to PMB and Scheme
Protocols. Non PMB limited to
R31 900 per family per annum.
HIV / AIDS:
HIV Management Programme.
International Travel Benefit:
Limited to emergency medical cover
up to R2 million per beneficiary per
incident
